Gentle Medicine: Two Doctors Discuss How Less Can Be More in the Treatment of Lyme Disease and Chronic Illness

by Cynthia Quattro, PA, DAOM, LAc, and Bob Quinn, DAOM, LAc

On February 3, 2013, Super Bowl Sunday, Cynthia Quattro, PA, DAOM, LAc, sat down with Bob Quinn, DAOM, LAc, to talk about an integrative approach to chronic Lyme disease. Dr. Quattro has been treating chronic Lyme patients for many years now and has developed an approach that combines the best of German biological medicine, acupuncture, prescription medications, and nutritional supplements.

BQ

: Cynthia, I want to first of all thank you for making the time to chat and share your insights and the benefit of your experience in treating chronic Lyme disease. My intent here is twofold: I want to generally discuss how Chinese medicine’s thinking and strategies come into play in how you treat your chronic Lyme patients and how you manage to integrate that with a more reductionist Western biomedical kind of analysis; but I also want to get at specifically the German biological medicine (GBM) piece. You have been using the GBM remedies longer than I have, and I am interested in what you can share about this unique European approach and its theories.

CQ

: I’m happy to make my time available.

BQ

: Before we start, I want to lay bare my own bias, developed in the last 7 years of treating chronic Lyme patients. I wrote an article a few years ago for an online journal and called it “A Journey into Gentle and Simple.” It told of my studies of Japanese Meridian Therapy and my ever-unfolding appreciation for gentle approaches to treatment – for the power of the gentler ways of practicing Chinese medicine versus stronger stimulation styles. This comes into play with chronic Lyme disease in my experience. Even with exceedingly gentle and subtle treatment styles, these chronic Lyme patients are easily overstimulated and thus pushed further into exhaustion. That is obviously not good. That was my initial attraction to GBM. It does not overstimulate these patients. And yet the remedies are so helpful and effective. So, I wanted my own personal bias toward less stimulation and gentler treatment out in the open. With all that now being said, I want to start by having you describe your medical background. Also talk a bit about how you came to work with chronic Lyme patients.

CQ

: Before I discuss my background, I will just say quickly that I agree with you wholeheartedly that this group of patients requires sensitive and gentle treatments. I suspect that we will come back to this theme in our conversation again and again. Just to go quickly through my own educational background, I have been practicing Oriental medicine therapies for 22 years. This part of my practice began after practicing in a more biomedical environment as a physician assistant (PA). In 2007 I completed my doctoral studies in Chinese medicine. That is called the DAOM degree, Doctor of Acupuncture and Oriental Medicine. My PA education was a four-year program. I initially thought that after that, I would become a naturopath. I sought out the PA education to get a good grounding in medical science first. One of the reasons that I left that plan and decided to study Chinese medicine instead of naturopathy is because of an experience which I had while working as a PA in a state-of-the-art, integrative medical center in New York City. I felt that there was something missing, even from the natural medicine protocols, nutrition, and vitamin therapies. The turning point for me was when I started to refer my patients to one of the in-house acupuncturists. I started to see better results, and that really impressed me. So, I wanted a practice where I could combine both Chinese medicine and biomedicine. I looked at a number of schools around the country and decided to study Chinese medicine in San Francisco. That school had at the time some of the best Chinese herbal doctors on staff, and that was a big draw for me.

Let me then fast forward to my current practice in Santa Cruz, California, where I have been for more than15 years. It is an integrative clinic with an MD, massage therapist, an RN, an ND; it offers acupuncture too, of course, through me. In this clinical setting I tend to specialize in chronic diseases.

BQ

: What draws you to the chronic cases?

CQ

: I find that conventional medicine is very good at acute conditions. My patients tend to have a primary care doctor for their more urgent medical conditions. However, regardless of the level of medical insurance carried, the medical system does not do enough for people with chronic conditions. In these cases, we need some real attention and focus to get to the root of their illnesses. This is due in part to a multitude of errors in the health-care system.

BQ

: You say a multitude of errors. What are the biggest errors, in your opinion?

CQ

: Time. They simply do not allow enough time with these chronically ill patients. Without investing some time, allowing the patient to tell his or her story, there is no chance that you will get to the root of things. Another big issue is the lack of a viable concept of health. The only accepted definition of health in that system is a lack of pathology. Chinese medicine has an important contribution to make in that respect, because there is a real philosophical richness to its theories and descriptions.

BQ

: In your focus on chronic disease, I am assuming it is in that vein that you first encountered chronic Lyme patients?

CQ

: Yes. At first it was a number of patients who said they had chronic candida, or yeast overgrowth. They complained of many of the same symptoms that people now associate with chronic Lyme disease, but we didn’t know yet of Lyme at that time.

BQ

: And these symptoms were … ?

CQ

: Fatigue, brain fog, dizziness, digestive disturbances, and various kinds of pain syndromes.

BQ

: At this point in time before Lyme disease was generally known, what did your treatment of this condition look like?

CQ

: We gave antifungal medications, antioxidants, nutritional guidance, vitamins, and supportive therapies. Sometimes they would get better, but often they needed to stay on these antifungal medications in order to hold any improvements in their symptoms. And, of course, that is not always a good idea. Eventually, I started to hear more about Lyme disease. At that time it was still largely unknown.

BQ

: Where did you first catch wind of chronic Lyme?

CQ

: There was a small conference at UCSF [University of California, San Francisco]. Maybe this was 10 or 12 years ago. This small group of maybe 20 doctors was talking about the growing need for more clinical research. One of the doctors there had experienced personally a severe case of Lyme and had struggled to get well, which prompted this group of doctors to meet. They decided to focus on the need for better testing, and treatment. Eventually better testing was developed, though Lyme testing continues to be somewhat of an issue.

BQ

: Can you cover this issue of testing just a bit? I think that many practitioners, certainly acupuncturists, since they do not draw blood and send out for labs, are unaware of how Lyme is tested.

CQ

: Well, when we got more accurate testing – more on that in just a bit – we discovered that many of these patients who had been so hard to treat had in fact chronic Lyme disease. Before this testing they had been thought to have candida, or some of them were diagnosed with depression or chronic fatigue. Some of them had been diagnosed with neurological conditions like multiple sclerosis. If Lyme disease progresses into the neurological system, the clinical picture can look a lot like these debilitating conditions.

BQ

: Of course it is good to have better, more accurate testing, but I’ll bet at that point it did not make them much easier to treat.

CQ

: Right. Still a difficult condition to work with, but it is always better to know the scope of the disease you are facing. So let me talk a bit about the testing. The most common and the most accurate test for Borrelia burgdorferi (Bb) is the western blot test. It’s an antibody test, which measures the body’s immune response to the presence of the proteins specific to the bacteria that causes Lyme. Seeing this kind of bacteria under a common microscope or culturing it is not easy to do, since it has unique characteristics. So, even though there is an effort to culture it, the western blot is presently the standard of care for diagnosis. Now, a bigger challenge is that there are many variants of Bb, not to mention the common coinfections Babesia and Bartonella, which can considerably complicate the diagnosis. Clearly, there is more than one area where the testing can improve.

Another limitation is that what the test measures is somewhat a reflection of an individual’s immune system, and every person’s immune system is unique. So when they’re looking at these antibodies, they are in part reflecting the person’s own immune defenses. For instance, if someone has an underactive immune system, the patient may not show the full expression of the antibodies against Lyme bacteria, and if the patient has a hyperactive immune system, the antibodies may be overexpressed. For instance, in the case of rheumatoid arthritis, an autoimmune condition, someone may show a positive response on the Lyme test that may be accurate but may also be nuanced by the hyperreactivity of the immune system. If the person is taking steroid medications, that too can change the results. Autoimmune thyroid conditions could also skew the test’s response, so we have to be careful to interpret what these tests really mean in relation to the individual’s immune condition.

BQ

: So, we lack a truly definitive test for chronic Lyme, one that produces iron-clad results?

CQ

: Right, and as a result, chronic Lyme has largely become a clinical diagnosis.

BQ

: If it looks like a duck, walks like a duck…

CQ

: Right. The physical exam does not exactly reveal a definitive diagnosis of Lyme either. Sometimes patients will have symptoms more typical of Lyme, like swollen joints or lymph nodes. But these can be symptoms of conditions that are not Lyme related. So in my practice I use functional medicine tests such as nutritional analysis, stool tests, organic acid tests, hormone testing, and so on to help to understand better what else is affecting the person’s health. Of course, a history of a tick bite or a bull’s-eye rash, even though reports have shown that only about 30% of those infected ever have this, helps with the diagnosis.

BQ

: Heiner Fruehauf, PhD, LAc, who specializes in Lyme disease, has a basic differentiation of “Gu syndrome” (Gu is an ancient Chinese concept that in many respects closely parallels chronic parasitic superinfections) into brain-Gu and digestive-Gu. I was wondering if you have teased out a personal way of seeing the common patterns of chronic Lyme.

CQ

: Yes, I agree with Heiner, and I have seen three similar physical patterns. There are some patients with persistent dizziness who may or may not have brain fog along with it. Some just have the brain fog. Fatigue is another common condition, sometimes to the degree of exhaustion. And there are also the musculoskeletal syndromes such as rotating achy joints and muscle pain.

My patients generally have a primary care provider who has already done standard blood tests, or if they have seen other specialists, which many of these patients have, I ask them to bring these labs for me to review. When they do bring their labs to me I find that they are often not specific enough to understand what is at the root of their illness. Many of these patients have already seen a Lyme specialist and have often been on many courses of antibiotics. And, sadly, many still have had no significant results. And in these kinds of cases, I find that Oriental medicine really shines. Its subtler diagnostics of pulse, tongue diagnosis, channel and abdominal palpation, all offer a layer of insight that still escapes a Western biomedical view, whether it is standard care or integrative care. These body signs show not only the constitutional tendency but also where the body is weakening due to the illness. This is invaluable in terms of a treatment plan. This can guide the treatment, and can be used as a benchmark to measure improvement. The body reveals its condition if there is training to read these more subtle signs. Many practitioners are forced to work in the dark, so to speak, because they do not have these subtler diagnostic techniques of Oriental medicine.

BQ

: Maybe you could give us a sense of how this might work in your clinic with a new patient.

CQ

: Sure. Say someone comes in with the complaint of chronic headache or fatigue. The person might seem rather depleted, complaining of exhaustion. This is not the kind of patient to whom I would immediately recommend a double course of antibiotics, although some Lyme experts might prescribe them as a standard-of-care type of protocol. I feel that an assessment of their vital health is essential before suggesting an enduring treatment that forces the body to adapt to a potent prescription regimen. First, I recommend missing nutrients, then rebuild the immune system if necessary and regulate the hormones, especially adrenal function. Often the person’s immune system is too weak or too compromised or too confused by all the various therapies that were already prescribed and needs restorative care. The key is to slowly rebuild strength and also use gentle detoxification. The remedies of GBM have a key role in this strategy.

BQ

: And how does the Chinese medicine element look here?

CQ

: Clinically, I focus on the evaluation of the abdomen and body points. Of course, I also take the pulse and look at the tongue to get some sense of the nature of their constitutional imbalance at play. After I get this more clear diagnosis, I can determine where to go with the patient. For instance, if someone presents with joint pain and has hives or some type of eczemalike rash, this person may tend to be warmer or hot natured. (Note: The redness of the rash in this instance is taken as a sign in Chinese medicine of the presence of Heat at the surface.) But maybe the patient’s digestion has no obvious complaints. A second patient, also with the same chronic Lyme diagnosis, might mainly be complaining of horrible joint pain that is worse in cold weather. (Note: This would be seen in Chinese medicine as a Cold-natured disease process.) Although they have the same diagnosis in biomedicine, they have a different diagnosis in Oriental medicine and will not receive the same treatment. However, for most Lyme-literate physicians, the biomedicine approach is standardized regardless of the way that the patients report. Chinese medicine’s ability to identify different types and utilize appropriately matching strategies is a real strength. It can also help me in some instances to pick out the best GBM remedies as well.

BQ

: In terms of Traditional Chinese Medicine (TCM) patterns, what are the most common ones you see?

CQ

: Kidney-Liver Yin Deficiency; these same patients might also have Kidney-Heart Disharmony. These are the most volatile of patients. They are also the ones who tend to have autoimmune conditions. They might often have diagnoses such as interstitial cystitis, fibromyalgia, maybe thyroid instability. Their thyroid condition might tend to be an autoimmune problem. They also can have lots of pain and nothing seems to give them comfort. They may also have more insomnia and dizziness. The next category is the Spleen Deficiency category, a sort of digestive insufficiency, you might say. The ones who have this digestive weakness and also some Heat are the ones with emotional issues like anxiety. Heat in the Blood, you might say. Then some Spleen Qi Deficiency patients also have a more Liver Congestion to deal with. This group has the worst digestive problems. They may be more toxic and require more cleansing. If this condition progresses to Spleen and Kidney Yang Deficiency, the patients seem to develop more problems with phlegm or fluid accumulations. Many have chronic sinus conditions, and maybe cognitive decline. In these cases there might also be a Deficiency of Lung Qi leading to increasing fatigue and even chest pain.

BQ

: Talk a bit about how the prescription drugs play a part in your treatment plan, since as a PA you are able to do that.

CQ

: I do prescribe antibiotic and antifungal medications when I feel they are necessary. However I always support them with nutritional supplements when I give these drugs, and I always like to give them an herbal constitutional remedy. This may also be an entry point when I recommend GBM to begin a gentle detoxification. So, essentially I see every patient as unique, and I treat all of them according to their needs and their constitution. The program for each one is then quite different.

BQ

: As I listen to you differentiate your approach from that of doctors without the lens of Chinese medicine, I see an obviously clear benefit to having the Chinese medicine in the mix, and I like how you laid that out. Let’s go back for a moment to the idea that I expressed at the beginning about gentle styles of treatment for these chronic Lyme patients. It is not a standard part of TCM training in the US to learn how to work gently enough to succeed with these patients. Maybe a few of the TCM colleges have a course or two in Japanese meridian therapy, and that is a start, but even that is not enough really. I know you yourself practice Shakuju therapy, a very subtle and comfortable style of acupuncture, in which needles are rarely inserted into the body. Instead more surface techniques are used. I have studied Shakuju as well, and Toyohari, and include it in how I work with chronic Lyme cases. It seems then we are on the same page in Chinese medicine – that these patients are very easily overstimulated by “normal” acupuncture and that gentler ways have to be used. Many practitioners don’t seem to believe this. This conviction on my part that these patients benefit most of all from gentle therapies is what led me to GBM. These remedies do not overstimulate the patients. In some cases, it is just unbelievable how quickly they benefit when the right GBM remedy is given. Can you say anything about this dance between giving enough stimulation, enough therapy to get a change, and not giving too much?

CQ

: Sure. I like to think of it best described by the term hormesis. This concept is used more often in homeopathy. It describes the fact that lower doses are more powerful than higher doses. It essentially refers to the innate plasticity of the biological systems, its self-surviving adaptability. Hormesis emphasizes that low dose is stimulation and high dose is inhibition. I that think these treatments trigger this innate flexibility.+

In my acupuncture for these patients, it is gentle, and it does include the Shakuju methods taught to me by Kobayashi Sensei, the originator of this style. And, yes, this is a non-needle-insertion style. It benefits all types of patients, but the ones that are the most volatile, the Kidney-Liver Yin Deficient type, who really cannot tolerate even superficial needle insertion, benefit well from this gentle style. I know this from experience. These people will tell you clearly that they cannot handle needle insertions, and have avoided having acupuncture.

BQ

: Well, the average acupuncturist, due to the limitations of his or her training is lost as soon as the patient says, “No needles, please.” They don’t know what to do if they can’t put a needle in. They can end up like some of the insensitive and frustrated biomedical practitioners where they just say the whole problem is in the head of the patient, that they are crazy or neurotic or depressed. I’ve seen this.

CQ

: Right. In those cases I can rely on the Shakuju approach and do an entirely non-needle-insertion treatment, and generally this style is helpful for these sensitive patients. I think the gentle approach honors the complex nature of what it takes to heal. In theory, it might be that in working this way on the skin surface of the body that we are relaxing the Wei Qi, the most external defensive layer of the body that protects the skin. Opening the surface or epidermal layer encourages the pathogens to be drawn from the deeper layers upward, where they are easier to treat and release. This is clearly an Oriental medicine concept that biomedicine has no reference to. Also, more in reference to fetal embryology, the skin, or epidermis, originates from the same ectoderm as the central nervous system. It is extremely thin but a vast sensory organ. According to the skin scientist Mitsuhiro Denda, the epidermis has the same receptors as the brain for neurotransmitters such as serotonin and dopamine, and the various sensations received at these receptors are communicated to the brain. Essentially, the brain understands the condition of the outside world through sensory perception of the epidermis.

BQ

: As I understand in Shakuju therapy, the main focus is on strengthening the body’s own ability to fight off pathogens. It does not fight the pathogens directly, you might say.

CQ

: Yes, that’s true. This gentle method strengthens and regulates the energy both at once. When I give this kind of acupuncture treatment, what I am looking for is patients to feel both relaxed and energized afterward. If it is too stimulating with deeper needles, they end up feeling more depleted than ever. I try to check in with them the next day, especially in the beginning of their treatments, to see how they are feeling. It is good to get their feedback, and the answer I am hoping for is that they feel lighter and clearer, not heavy and bogged down. This way I can follow patients’ progress and decide if they need even gentler treatment or if they are ready for slightly more aggressive treatment protocols.

BQ

: An added benefit of working this way with gentle therapies is that the patients themselves start to develop a greater sensitivity to what is going on in their bodies.

CQ

: Exactly, and that is no small thing. I typically ask them to chart their symptoms, physical and emotional, so that we can have a sense of how things are progressing. This way, we can follow subtle improvements, subtle enough that they might have been overlooked if they were not noted on paper. And I did want to say that I fully agree with what you said a moment ago about GBM being similarly gentle to these kinds of gentle acupuncture. I can vary the dosage depending on their condition and change remedies as they clear different symptoms. That has been my experience, and I am very glad that I have these medicines to work with now – not just with Lyme patients, by the way, but certainly with those who have chronic illness.

BQ

: I am still building my familiarity with all the product options in the various GBM product lines available. Do you have favorite products that you have found yourself going to time and again with your chronic Lyme patients?

CQ

: Yes, I do. I like to start with the PEKANA Basic Detox Kit. This drainage kit has three products that target the kidneys, liver, and lymphatic system. Whether patients have Lyme disease or not, I start them on this basic level of detoxification. I find that even though it is very subtle, I see a difference in the patients, and they become more responsive to the following treatments. This is one of the reasons that I like to start with this gentle detoxification. I don’t like to start with stronger cleansing or purging protocols and certainly not for anyone with chronic Lyme disease. They can be too depleting. I like using the product MUNDIPUR. It’s one of my favorites as well. It tends to clear the gall bladder and the sludge that can build up there. The Gall Bladder as one of the “hollow organs” of Chinese medicine is a storage organ. We know that anatomically, gall bladder stores bile and can also store sludge and even the Lyme bacteria. So I think it is important to cleanse the gall bladder early on in a gentle way. I don’t like the idea of purging it either, especially for these compromised patients.

BQ

: And other products?

CQ

: I like the PEKANA TOXEX, which is a bit of a stronger cleanser, especially if there has been a history of multiple medications or substance abuse of one sort or another. The OPSONAT is a remedy that I like to use for patients who seem inflamed, not only inflamed mucous membranes, but also for symptoms that I described before as having hot and fiery symptoms. I do think of a treatment plan to treat chronic infections in terms of four basic principles:

1. eliminate the pathogen

2. remove the inflammation

3. clear the stagnation of qi and blood

1. support the immune system

The last two of these four principles are largely missing from the biomedicine protocols for chronic Lyme disease.

BQ

: And how do the GBM remedies fit into this fourfold regimen?

CQ

: I like to use the SyDetox from Syntrion to address inflammation. I use it more for digestive symptoms. It helps with IBS and GERD. Sometimes these patients tend to have a sort of chronic gastritis, inflammation of their stomach lining. They have trouble eating and have many foods that trigger them. The SyDetox works well for them. I also like PSY-stabil. It’s calming for mood instability and irritable bowel as well.

BQ

: These are all great tips. My belief is that there are a lot of practitioners in our field of Chinese medicine who have patients coming through the door every day, maybe with a Lyme diagnosis and maybe without, but clearly presenting with this confusing array of symptoms. I remember Heiner Fruehauf talking about his first experiences with these patients. He said that if you follow the normal Chinese way of analyzing these cases, you get nowhere. It doesn’t work. That’s the very definition of Gu syndrome really. I think there are a lot of Lyme patients out there, and there are a lot of acupuncturists-herbalists who need help in figuring out how to get somewhere with these patients. And I hope that they can get their hands on this book so that they have the benefit of your experience and Heiner’s experience. No sense reinventing the wheel. There are good treatment strategies out there in acupuncture, herbal medicine, moxa, bodywork, German biological medicine. But again what is maybe most important is for practitioners to learn to be ever-cautious about moving gently with chronic Lyme patients – that these patients are already overstimulated and as a result are depleted.

CQ

: I can certainly affirm all of that. I’m reminded of one thing that my teacher always said. He liked the story of the wind and the jacket. He said, no matter how hard the wind blows, it cannot blow a jacket off the body. In fact, the jacket will be hugged even tighter against the body. The sun, however, with its warmth, creates the condition internally where the jacket is taken off naturally. This is what our treatments should mimic, like the warmth of the sun. We need to restore the body to a healthy metabolism and immune system wherein the healing process can unfold naturally.

BQ

: Right. I think what is missing, even in the integrative medicine approach is the concept of say, the Zheng Qi, the Righteous Qi. We can talk about immune competence, but the concepts are not the same really. To have as a target in treatment the restoration of a healthy Zheng Qi is such an improvement over the idea of just killing the pathogen, no matter how much damage the treatment does to other body systems. We can use the pulse diagnosis, the abdominal diagnosis, channel palpation, and tongue diagnosis to monitor how we are doing, how our treatments are helping or are not helping. It’s good to have an instant feedback system. We can have a sense even before we send that patient home that we have done something that has helped reawaken, reinvigorate the patient’s Zheng Qi.

CQ

: I totally agree.

BQ

: Let me jump to what you were saying about PSY-stabil and mood stability. That is a unique aspect of chronic Lyme, the particular sort of anxiety that accompanies this condition. Some people come in and say that they feel possessed. Remember, the ancient concept of Gu was literally “demon possession.” Without ever reading about Gu, people use this language, that they feel possessed, not like themselves, and they are deeply worried in a way that I had never seen before with other conditions. There can be a sort of emptiness in their eyes that is almost diagnostic as far as I am concerned for chronic Lyme. I see it nowhere else. And because of this anxiety, they are driven, absolutely driven, to read anything they can get their hands on, to try a million different remedies all at once, to skip back and forth between strategies. Anything you can say about this anxiety? They all seem to have it to one degree or another, regardless whether they have Brain-Gu or Digestive-Gu, regardless of the TCM pattern that you would diagnose.

CQ

: I do see that too. I think perhaps it is tied in with their alarm system, and particularly due to their exhausted adrenal function. I do measure adrenal hormones and I see huge amount of adrenal burnout. I think that this has a lot to do with the progression of their condition and the course of how they became so ill. A lot of these patients before they became sick were very productive and had great minds, and when they notice a considerable drop in their cognitive capabilities and their ability to get things done in the world, it is devastating and anxiety producing. This is real stress and needs to be treated as seriously as the disease itself.

BQ

: Right. Some of these patients actually lose their jobs because they can no longer function in the way that they once did.

CQ

: Yes, that is true, and I have seen chronic Lyme patients who have become disabled. I think that anxiety is in part the fear of how much function has been lost. There is the worry that it could keep progressing to the point where they cannot take care of themselves at all. This fear is worse if they have already gotten a lot of treatment and have not gotten anywhere in the process – except more in debt. So, I think this is the type of burnout that is common to chronic Lyme and is related to out-of-balance adrenal hormones and lack of balanced nutrition. And there is also the issue that has to be mentioned of what these patients are enduring socially. The supportive circle of family and friends around them may or may not recognize the severity of the condition. If you look at most Lyme patients without a trained eye, you will think that they look pretty normal. It might seem like a stretch that they have a chronic illness.

BQ

: So, they may not be getting the kind of community and family support that they really need.

CQ

: Exactly. And it is so important. If the necessary level of support is not there, this creates more anxiety as well.

BQ

: Even in those cases where the partner supports the patient, what I have seen is that the patient edits himself or herself at home. They know that everyone has a limit. They would be better served by more discussion and dialogue at home, but they hesitate to give voice to all that is going on for them. They fear that they will overwhelm the other person and then lose the crucial support that they need. So this is a problem even when it looks as if the husband or wife is fully onboard and sympathetic. You mentioned this adrenal connection, and of course in Chinese medicine there is the connection between the Kidney organ-network and fear. The adrenals for certain belong to the Kidneys in Chinese medicine. So that adrenal depletion and imbalance is coming from this fear, and then as you explained, the fear leads to this anxiety state that they live in. It’s a big issue.

CQ

: Yes, it is a common issue. We have not yet talked about diet, but if they are eating the wrong diet, it equally contributes to the progression of their illness. Although there is no one diet for Lyme disease, I talk to my patients about Yin and Yang foods. Once their constitutional tendency is known, foods choices help to support their condition. This is not a focus in functional nutrition, but for example, if someone is very dry, skin, eyes, throat, which I see in the more inflamed patients, foods that are more Yin are recommended.

BQ

: What are your favorite foods in this instance when you want to nourish the Yin?

CQ

: Although I would take a broad overview of their diet, an example would be foods like berries, squashes, light fats and oils, even coconut to moisten the connective tissues. Eating spicy foods or herbs, on the other hand, would only make them feel worse or cause more dryness in this case.

BQ

: As a final point of discussion, I want to raise a strategy in Lyme treatment that I think not many others are making note of, and that is the role of bodywork, structural work, movement work. I practice Sotai. My main Sotai teacher, Peter Thompson, practices just a very short distance from Old Lyme, Connecticut, where this whole disease seems to have started. He has seen many Lyme patients. I use Sotai in every treatment that I do for Lyme patients and am convinced it has an important role. Some years back, Dr. [Joseph] Mercola interviewed Dr. [Nicholas] Gonzalez, the famous integrative oncologist, and Dr. Gonzalez said something interesting at one point. He said that there are certain patients who are just not going to make the desired progress in therapy until they get what he called “structural work.” He left it unclear if he meant Rolfing or Feldenkrais or somatics, and there are many other associated therapies that he could have had in mind. I am beginning to think that this is true with chronic Lyme patients. Dr. Gonzalez said that he could not tell by looking at someone if he or she was in this group that would need the structural work. In other words, it was not gross structural asymmetries that determined the need. I mention this to you for feedback because you have seen a lot more Lyme patients than I have and, although we did not go into it in your background, I know that you attended massage school a long time ago. And your main acupuncture teacher Kobayashi Sensei, at least when I studied with him, has a keen eye for structure. I don’t think that Swedish massage will do the trick here, by the way. Of course that is relaxing and helpful in its own way, and I don’t want to minimize it and how much it can help, but I am talking about something different here. Do you think that there is anything to what I am saying?

CQ

: Yes, I think this is particularly true of the very inflamed patients. These are the ones who have fibromyalgialike symptoms or chronic neck pain. At times I have seen that when I send them to physical therapy, they actually get worse. They can’t tolerate that level of intervention at all. Even when I ask physical therapists to try a gentler approach, and they do, it is still not gentle enough. The patients come back to me and refuse to go back to PT. But these patients still need what we could call “informed touch”; they need that type of touch because of how it ramps down their state of agitation. Beyond that, of course, is the benefit of the correction of structural imbalances and the pain that they engender. I do refer to cranial-sacral therapists and I also like the gentle rocking nature of something like Trager massage. It is like medicine for the nervous system. It supports the patient but does not increase inflammation. And this kind of touch usually induces the patient into a parasympathetic state, the calming state of awareness that turns off the driving sympathetic function that is more active most of the time. This is when the brain-wave pattern, if it was measured, would go into an alpha-wave state. It is a meditative mind state and is what acupuncture has been proved to induce by gentle needling.

BQ

: There is an issue a bit related here that Mark Seem, PhD, LAc, raises in some of his books, and that is about a bias toward thinking the internal medicine strategies more important than the physical medicine ones. Lyme is clearly an internal medicine condition. We have organs functioning in a suboptimal way due to an ongoing infection. No doubt about that. But that does not mean that so-called physical medicine interventions, whether gentle acupuncture or this type of bodywork that we are now discussing, are inappropriate or somehow of a lower-rung importance. I can cite cases of certain Lyme patients for whom the physical medicine piece was most important. Again, this raises the question of how we know which patients need more of this type of work and which ones need us just to focus on other approaches. I don’t have an answer there.

CQ

: This brings to mind another type of Lyme patient. There are some who, even when you do the gentlest possible acupuncture, cannot relax. They never really let go when on the treatment table and allow themselves to drift into that parasympathetic state that they desperately need. You leave them alone for 10 minutes and come back and they are staring wide-eyed at the ceiling. For these patients, I think what you are talking about is especially important.

BQ

: So, I’m not crazy.

CQ

: No. There really is an important role for what you bring up. And that leads to maybe the final point to be made. We made this time to talk about German biological medicine and how it plays a role in my integrative approach to treating chronic Lyme disease, and I hope that the point has been made that I am much more effective now that I have these remedies to work with. And I know that over time I will become familiar with more of their products. That point is made, but I hope in this far-ranging discussion that another point has been made implicitly, and I want to make it now explicit: We need many tools and treatment strategies if we are to help our patients recover from chronic Lyme or any chronic disease, and if we are to help them restore a quality of life experience that has been lost. We need GBM, medications, counseling, bodywork, nutrition, supplements, acupuncture, herbs, moxa. All these are important, and I am doubtful if any one of them, even in the hands of a master, is enough. Lyme is just too complex. But we are optimistic, because every day we are discovering more and finding better ways of helping these patients.

BQ

: Cynthia, I want to thank you for making the time on Super Bowl Sunday to talk with me.

CQ

: I’m happy to be part of this project and hope that, in the end, more people are helped by practitioners who feel more confident to treat these complex patients.

Cynthia Quattro is a physician assistant and doctor of acupuncture and Oriental medicine. She is an educator, author, and speaker in integrative medicine, and has a medical practice at the Pacific Center for Integral Health in Santa Cruz, California, where she specializes in treating chronic diseases. For more information: www.drquattro.com.

Bob Quinn is an associate professor in the Classical Chinese Medicine Department at National College of Natural Medicine (NCNM) in Portland, Oregon, where he also has a private practice. He is at work on a book on an integrative approach to chronic Lyme that incorporates Chinese medicine and German biological medicine.